標(biāo)危川崎病患兒對(duì)兩種大劑量丙種球蛋白方案療效分析及外周血淋巴細(xì)胞與T細(xì)胞亞群相關(guān)性分析
發(fā)布時(shí)間：2018-09-10 13:27
【摘要】：第一部分標(biāo)危川崎病患兒對(duì)兩種大劑量丙種球蛋白方案療效分析 目的通過(guò)對(duì)篩選后的川崎病臨床資料進(jìn)行回顧分析，探討兩種大劑量靜脈注射丙種球蛋白（intravenous immune globulin IVIG）方案對(duì)標(biāo)危川崎�。↘awasaki diseaseKD）患兒的臨床療效及優(yōu)選方案。 方法94例KD標(biāo)�；純篬為KD未合并冠狀動(dòng)脈病變（Coronary artery lesionsCALs）高危因素患兒，入院時(shí)小林評(píng)分（Kobayashi risk score）7分]，按IVIG給藥劑量分為A組（1g/kg單次使用，36例）及B組（1g/kg連用兩天，58例），對(duì)兩種方案療效進(jìn)行回顧性對(duì)比分析。觀察兩組患兒住院天數(shù)，熱退時(shí)間，及粘膜充血、皮疹、手足腫脹及頸淋巴結(jié)腫大消退時(shí)間；檢測(cè)外周血白細(xì)胞計(jì)數(shù)（WBC）、血小板計(jì)數(shù)（PLT）、血紅蛋白計(jì)數(shù)（Hb）、C-反應(yīng)蛋白（CRP）、紅細(xì)胞沉降率（ESR）恢復(fù)情況以及CALs隨訪分析；并對(duì)兩組組內(nèi)、組間及治療前后結(jié)果進(jìn)行比較分析。 結(jié)果兩組治療方案在住院天數(shù)、急性期癥狀消退時(shí)間均有顯著療效，組間比較無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）；兩組WBC、CRP、ESR指標(biāo)與治療前比較均明顯降低（P0.01），PLT計(jì)數(shù)較治療前顯著升高（P0.05），Hb計(jì)數(shù)變化不明顯，差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；治療后A組CALs發(fā)生率為16.67%（6/36），B組CALs發(fā)生率為18.97%（11/58），在10周內(nèi)隨訪結(jié)果均恢復(fù)正常，兩組比較差異亦無(wú)明顯意義（P0.05），其中僅A組1例為IVIG耐藥病例。 結(jié)論對(duì)KD未合并CALs高危因素患兒而言，IVIG1g/kg單次使用在急性期癥狀消退、炎性指標(biāo)恢復(fù)及預(yù)防CALs方面與1g/kg連用兩天比較具有同樣的近期及遠(yuǎn)期療效，可推薦為標(biāo)危KD的優(yōu)選治療方案。 第二部分川崎病外周血淋巴細(xì)胞與T細(xì)胞亞群的相關(guān)性分析 目的探討川崎�。↘awasaki disease KD）患兒外周血淋巴細(xì)胞與T細(xì)胞亞群的相關(guān)性，為川崎病免疫學(xué)機(jī)制研究提供參考。方法47例川崎病患兒及對(duì)照組51例支氣管肺炎患兒，，入院后同時(shí)采集外周血檢測(cè)淋巴細(xì)胞計(jì)數(shù)、比例，以及T細(xì)胞亞群包括CD3+、CD4+、CD8+、CD4+/CD8+及CD56+CD16+百分比。分別對(duì)各項(xiàng)結(jié)果進(jìn)行相關(guān)性分析。結(jié)果川崎病組外周血淋巴細(xì)胞計(jì)數(shù)及比例與CD56+CD16+均呈負(fù)相關(guān)（r=-0.369，P0.05vs r=-0.316，P0.05）；川崎病組及對(duì)照組淋巴細(xì)胞比例與CD3+（r=0.384，P0.01vs r=0.283，P0.05）及CD4+（r=0.511，P0.01vs r=0.326，P0.05）呈正相關(guān)。兩組淋巴細(xì)胞計(jì)數(shù)及比例與其他T細(xì)胞亞群（CD8+及CD4+/CD8+）均無(wú)相關(guān)性（P0.05）。結(jié)論外周血淋巴細(xì)胞與T細(xì)胞亞群的相關(guān)性結(jié)果提示T淋巴細(xì)胞參與川崎病急性期的免疫反應(yīng)機(jī)制，對(duì)川崎病發(fā)病機(jī)制研究可能有輔助意義。
[Abstract]:The first part: efficacy analysis of two high dose gamma globulin regimens in children with Kawasaki disease objective to retrospectively analyze the clinical data of Kawasaki disease after screening. To investigate the clinical efficacy and optimal selection of two high dose intravenous immunoglobulin (intravenous immune globulin IVIG) regimens in children with (Kawasaki diseaseKD) with risk of Kawasaki disease. Methods 94 children with KD risk [KD without coronary artery disease complicated with (Coronary artery lesionsCALs) risk factors] were included in this study. On admission, Xiao Lin score (Kobayashi risk score) 7) was divided into two groups according to the dosage of IVIG: group A (36 cases of 1g/kg) and group B (58 cases of 1g/kg for two days). The days of hospitalization, the time of heat withdrawal, the time of mucosal congestion, rash, swelling of hand and foot and the time of neck lymph node swelling were observed. Peripheral blood white blood cell count (WBC), platelet count (PLT), hemoglobin count (Hb) C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) recovery and CALs follow-up analysis were performed and the results were compared between the two groups and before and after treatment. Results there was significant curative effect between the two groups in the days of hospitalization and the time of symptom regression in the acute phase, but there was no statistical difference between the two groups (P0.05). Compared with before treatment, the WBC,CRP,ESR counts of the two groups were significantly decreased (P0.01) significantly higher than that before treatment (P0.05), there was no significant difference between the two groups (P0.05). After treatment, the incidence of CALs in group A was 16.67% (6 / 36). The incidence of CALs in group B was 18.97% (11 / 58). The results of follow-up within 10 weeks all returned to normal, and there was no significant difference between the two groups (P0.05). Only one case in group A was IVIG resistant. Conclusion single use of IVIG 1g / kg in children with KD without CALs risk factors has the same short-term and long-term effects as that of 1g/kg for two days in the recovery of acute symptoms, the recovery of inflammatory indexes and the prevention of CALs. It can be recommended as an optimal treatment regimen for KD. The second part: correlation analysis between peripheral blood lymphocytes and T cell subsets in children with Kawasaki disease objective to explore the correlation between peripheral blood lymphocytes and T cell subsets in children with Kawasaki disease (Kawasaki disease KD) and to provide reference for the study of immunological mechanism of Kawasaki disease. Methods 47 children with Kawasaki disease and 51 patients with bronchopneumonia were included in the study. Peripheral blood lymphocytes were collected at the same time and T cell subsets including CD3 CD 4, CD 8, CD 4 / CD 8 and the percentage of CD56 CD16 were collected at the same time. Correlation analysis of each result was carried out respectively. Results in Kawasaki disease group, the number and proportion of peripheral blood lymphocytes were negatively correlated with CD56 CD16 (r = 0.369p 0.05 vs r = 0.316P 0.05), and positively correlated with CD3 (r = 0.384p 0.01 vs r = 0.283P 0.05) and CD4 (r = 0.511P 0.01 vs r = 0.326P 0.05) in Kawasaki disease group and control group. There was no correlation between lymphocyte count and percentage of T cell subsets (CD8 and CD4 / CD8) in both groups (P0.05). Conclusion the correlation between peripheral blood lymphocytes and T cell subsets suggests that T lymphocytes are involved in the immune response mechanism of Kawasaki disease and may be helpful to the study of the pathogenesis of Kawasaki disease.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R725.4
本文編號(hào)：2234575
[Abstract]:The first part: efficacy analysis of two high dose gamma globulin regimens in children with Kawasaki disease objective to retrospectively analyze the clinical data of Kawasaki disease after screening. To investigate the clinical efficacy and optimal selection of two high dose intravenous immunoglobulin (intravenous immune globulin IVIG) regimens in children with (Kawasaki diseaseKD) with risk of Kawasaki disease. Methods 94 children with KD risk [KD without coronary artery disease complicated with (Coronary artery lesionsCALs) risk factors] were included in this study. On admission, Xiao Lin score (Kobayashi risk score) 7) was divided into two groups according to the dosage of IVIG: group A (36 cases of 1g/kg) and group B (58 cases of 1g/kg for two days). The days of hospitalization, the time of heat withdrawal, the time of mucosal congestion, rash, swelling of hand and foot and the time of neck lymph node swelling were observed. Peripheral blood white blood cell count (WBC), platelet count (PLT), hemoglobin count (Hb) C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) recovery and CALs follow-up analysis were performed and the results were compared between the two groups and before and after treatment. Results there was significant curative effect between the two groups in the days of hospitalization and the time of symptom regression in the acute phase, but there was no statistical difference between the two groups (P0.05). Compared with before treatment, the WBC,CRP,ESR counts of the two groups were significantly decreased (P0.01) significantly higher than that before treatment (P0.05), there was no significant difference between the two groups (P0.05). After treatment, the incidence of CALs in group A was 16.67% (6 / 36). The incidence of CALs in group B was 18.97% (11 / 58). The results of follow-up within 10 weeks all returned to normal, and there was no significant difference between the two groups (P0.05). Only one case in group A was IVIG resistant. Conclusion single use of IVIG 1g / kg in children with KD without CALs risk factors has the same short-term and long-term effects as that of 1g/kg for two days in the recovery of acute symptoms, the recovery of inflammatory indexes and the prevention of CALs. It can be recommended as an optimal treatment regimen for KD. The second part: correlation analysis between peripheral blood lymphocytes and T cell subsets in children with Kawasaki disease objective to explore the correlation between peripheral blood lymphocytes and T cell subsets in children with Kawasaki disease (Kawasaki disease KD) and to provide reference for the study of immunological mechanism of Kawasaki disease. Methods 47 children with Kawasaki disease and 51 patients with bronchopneumonia were included in the study. Peripheral blood lymphocytes were collected at the same time and T cell subsets including CD3 CD 4, CD 8, CD 4 / CD 8 and the percentage of CD56 CD16 were collected at the same time. Correlation analysis of each result was carried out respectively. Results in Kawasaki disease group, the number and proportion of peripheral blood lymphocytes were negatively correlated with CD56 CD16 (r = 0.369p 0.05 vs r = 0.316P 0.05), and positively correlated with CD3 (r = 0.384p 0.01 vs r = 0.283P 0.05) and CD4 (r = 0.511P 0.01 vs r = 0.326P 0.05) in Kawasaki disease group and control group. There was no correlation between lymphocyte count and percentage of T cell subsets (CD8 and CD4 / CD8) in both groups (P0.05). Conclusion the correlation between peripheral blood lymphocytes and T cell subsets suggests that T lymphocytes are involved in the immune response mechanism of Kawasaki disease and may be helpful to the study of the pathogenesis of Kawasaki disease.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R725.4
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